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Home My WebLink About4200 ASHE ROAD (8)Pes5 t ) %v SWRCB, January 2002 Page C of Secondary Containment Testing Report Form Thisform is intendedfor use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages ofthis form to report resultsfor all components tested. The completedform, written test procedures, and printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: PANAMA BUENA VISTA SCHOOL DISTRICT Date ofTesting: 10/14/11 Facility Address: 4200 ASHE ROAD, BAKERSFIELD Facility Contact: I Phone: Date Local Agency Was Notified of Testing: 8/26/11 Name of Local Agency Inspector (ifpresent during testing): CRAIG 2. TESTING CONTRACTOR INFORMATION Company Name: Rich Environmental Pass Technician Conducting Test: RICH PHILLIPS Not Tested Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: C6 UD40 A HAZ Manufacturer License Number: 809850 Manufacturer Training Component(s) Date Training Expires INCON TS -STS 6/11/2012 L NL87 ANNULAR X WASTE OIL ANNULAR 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made L NL87 ANNULAR X WASTE OIL ANNULAR X DIESEL ANNULAR X 11 WASTE OIL SEC PIPE 0 X UNL87 SEC PIPE X WASTE OIL SEC SUMP X DIESEL SEC PIPE X WASTE OIL FILL SUMP X UNL87 STP X 0 0 D DIESEL STP X UDC #1/2 X 0 UDC #3/4 X 0 0 0 UNL87 FILL SUMP 0 X 0 0 0 0 DIESEL FILL SUMP X UNL87 VAPOR BUCKET X 0 0 0 D 0 0 0 0 0 0 0 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, thefacts stated i document are accurate and infull compliance whit legal requirements Technician's Signature: Date: 10 /14 /11 SWRCB, January 2002 4. TANK ANNULAR TESTING Li5`1U n/ I n Page iof ' C Test Method Developed By: Tank Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: Pressure X Vacuum Hydrostatic Other (Specify) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: Tank # 87 Tank # DIESEL Tank #WASTE OIL Tank # Is Tank Exempt From Testing ?' Yes X No Yes X No Yes X No Yes No Tank Capacity: 12000 12000 500 Tank Material: STEEL STEEL STEEL Tank Manufacturer. UNKNOWN UNKNOWN UNKNOWN Product Stored: UNL87 DIESEL WASTE OIL Wait time between applying pressure /vacuum /water and starting test: 30MIN 30MIN 30MIN Test Start Time: 9:00 9:00 11:30 Initial Reading (R,): 10HG IOHG I OHG Test End Time: 10:00 10:00 12:30 Final Reading (RF): l OHG 1014G 1014G Test Duration: 60 MIN 60 MIN 60 MIN Change in Reading (RF -R,): 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 TesCResult: ;: X Pass :Fail X, Pass Fail X _P ss: Fail ass.: Fail Was sensor removed for testing? X Yes No NA X Yes No 0 NA X Yes No NA Yes No NA Was sensor properly replaced and verified functional after testin ? X yes No NA X Yes No NA X Yes No NA Yes No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code ofRegulations, Title 23, Section 2637(ax6)} SWRCB, January 2002 5. SECONDARY PIPE TESTING I-IM / -1/ Page — of Y f Test Method Developed By: Piping Manufacturer X Industry Standard Professional Engineer Other (Specify) Test Method Used: X Pressure Vacuum Hydrostatic Other (Spec) Test Equipment Used: 4" DIAL GAUGE Equipment Resolution: .5% Piping Run # 87 Piping Run # DIESEL Piping Run # Piping Run # WASTE OIL Piping Material: FIBERGLASS FIBERGLASS Piping Manufacturer: SMITH SMITH Piping Diameter: 3" 3" Length ofPiping Run: 50' 60' Product Stored: UNL87 DIESEL Method and location of i -run isolation: in BOOT IN SUMP BOOT IN SUMP Wait time between applying pressure/vacuum /water and starting test: 30 MIN 30 MIN NOT TESTED Test Start Time: 9:30 9:30 SINGLE Initial Reading (R,): 7PSI 8PSI WALL Test End Time: 10:30 10:30 LINE Final Reading (RF): 7PSI 8PSI Test Duration: 60 MIN 60 MIN Change in Reading (RF -R,): 0 0 PasslFail Threshold or Criteria: 0 PSI 0 PSI 0 0 7iest Result: _ X :`Pass l7 Fail XPass =. Fall 3 Pass;.: Fail' p Pass: QFal . Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) SWRCB, January 2002 6. PIPING SUMP TESTING 1" D`I U f I Page ___ of Test Method Developed By: Sump Manufacturer X Industry Standard Professional Engineer Other (Spec) Test Method Used: 0 Pressure 0 Vacuum X Hydrostatic Other (Specify) Test Equipment Used: INCON TS -STS Equipment Resolution: Sump # 87 Sump # DIESEL Sump #WASTE OIL Sump # Sump Diameter: Sump Depth: Sump Material: FIBERGLASS FIBERGLASS Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: CLEAN CLEAN Portion of Sump Tested' Does turbine shut down when sump sensor detects liquid (both roduct and water)?* S Yes No NA S Yes No NA Yes 0 No NA Yes 0No NA Turbine shutdown response time 5SEC 5SEC Is system programmed for fail-safe shutdown ?" X Yes No DNA X Yes No NA Yes No NA Yes 0 No NA Was fail -safe verified to be operational?* X Yes No NA X Yes No NA Yes No NA Yes No NA Wait time between applying pressure /vacuum/water and starting test: 30 MIN 30 MIN NOT TESTED Test Start Time: 9:47 10:22 9:47 10:22 NO Initial Reading (R,): 2.275 2.287 3.852 3856 SUMP Test End Time: 10:02 10:37 10:02 10:37 Final Reading (RF): 2.277 2.283 3.853 3.858 Test Duration: 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -Ri): 002 002 001 000 Pass /Fail Threshold or Criteria: 002 002 002 002 TesfResult X bass quail X Pass „ O Fall . i. 0 Pass _ p F;il 0 Pass t7F i Was sensor removed for testing? X Yes No NA X Yes No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? X Yes D No DNA X Yes No NA Yes No DNA Yes No NA Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) Ifthe entire depth of the sump is not tested, specify how much was tested. Ifthe answer to any ofthe questions indicated with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160) SWRCB, January 2002 7. UNDER- DISPENSER CONTAINMENT (UDC) TESTING Page of Test Method Developed By: UDC Manufacturer X Industry Standard 0 Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum X Hydrostatic 0 Other (Spec) Test Equipment Used: INCON TS -STS Equipment Resolution: UDC # 1/2 UDC # % UDC # UDC # 1UUD cturer: UNKNOWN UNKNOWN DC Material: FIBERGLASS FIBERGLASS UDC Depth: 29" 29" Height from UDC Bottom to Top of Highest Piping Penetration: 9" 9" Height from UDC Bottom to Lowest Electrical Penetration: 5" 5" Condition of UDC prior to testing: CLEAN CLEAN Portion of UDC Tested 12" 12" Does turbine shut down when UDC sensor detects liquid (both product and water)?* X Yes 0 No 0 NA X Yes 0 No 0NA Yes 0 No NA Yes No 0NA Turbine shutdown response time 5SEC 5SEC Is system programmed for fail- safe shutdown ?* X Yes No NA X Yes No NA Yes No NA Yes No NA Was fail -safe verified to be operational?* X Yes No NA X Yes No DNA 0 Yes 0N 0N Yes No DNA Wait time between applying pressure/vacuum /water and starting test 30MIN 30MIN Test Start Time: 11:30 11:47 11:30 11:47 Initial Reading (Ri): 2.197 2.197 3.855 3.856 Test End Time: 11:45 12:01 11:45 12:02 Final Reading (Rr): 2.197 2.197 3.856 3.856 Test Duration: 15MIN 15MFN 15MIN 15MIN Change in Reading (RF -Rj): 000 000 000 000 Pass/Fail Threshold or Criteria: 002 002 002 002 Test Result3`. X Pass ;Fail X Pass 0`Feil Passe . Fail Pass Fail. Was sensor removed for testing? X Yes 0 No NA X Yes 0 No NA Yes 0 No NA 0 Yes No NA Was sensor properly replaced and verified functional after testing? X Yes No NA X Yes No NA Yes No NA Yes No NA COMMentS — (include information on repairs made prior to testing, and recommendedfollow -up forfailed tests) 1 Ifthe entire depth of the UDC is not tested, specify how much was tested. Ifthe answer to any ofthe questions indicated with an asterisk(*) is "NO" or "NA ", the entire UDC must be tested. (See SWRCB LG -160) SWRCB, January 2002 8. FILL RISER CONTAINMENT SUMP TESTING 3`10' 1 Page -— of -2 Facility is Not Equipped With Fill Riser Containment Sumps 0 Fill Riser Containment Sumps are Present, but were Not Tested Test Method Developed By: 0 Sump Manufacturer X Industry Standard 0 Professional Engineer D Other (Specie) Test Method Used: Pressure 0 Vacuum X Hydrostatic Other (Specify) Test Equipment Used: INCON TS -STS Fill Sump Fill Sump # Equipment Resolution: Fill Sump # Fill Sump # rSumDiameter: SumpSump the Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: NOT TESTED Portion ofSump Tested Sump Material: Wait time between applying pressure /vacuum /water and starling test: 30MIN 30MIN 30MIN 30MIN Test Start Time: Initial Reading (Rj): Test End Time: Final Reading (RF): Test Duration: 15MTN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN 15MIN Change in Reading (RF -R,): Pass/Fail Threshold or Criteria: Test.Resnit : Pass . `FaII, .; Pass , .. ;'Fad , .'<, Pass. : O Fad . -. Pass . =Fad .' Is there a sensor in the sump? Yes 0 No Yes No Yes No Yes D No Does the sensor alarm when either product or water is detected? Yes No 0 NA Yes No NA 0 Yes No 0 NA 0 Yes No NA Was sensor removed for testing? 0 Yes No NA Yes No NA Yes 0 No NA 0 Yes No NA Was sensor properly replaced and verified functional after testing? yes No NA Yes No NA Yes No NA Yes No NA Comments -- (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) NO FILL SUMPS SWRCB, January 2002 9. SPILL/OVERFILL CONTAL MENT BOXES ti n`j of Page '7 of ! dl Facility is Not Equipped With Spill/Overfill Containment Boxes Spill/Overfill Containment Boxes are Present, but were Not Tested Test Method Developed By: Spill Bucket Manufacturer X Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum X Hydrostatic Other (Specify) Test Equipment Used: INCON TS -STS Equipment Resolution: Spill Box #87 VPR Spill Box # Spill Box # Spill Box # Bucket Diameter: 12" Bucket Depth: 16" Wait time between applying pressure /vacuum/water and starting test: 30MIN Test Start Time: 9:47 10:03 Initial Reading (R,): 3.323 3.322 Test End Time: 10:02 10:19 Final Reading (RF): 3.322 3.322 Test Duration: 15MIN 15MIN Change in Reading (Rr-R,): 002 000 Pass/Fail Threshold or Criteria: 002 002 Test Result:; Pass Fail -. 11 )QasS >: Fad.: D Pass. , 0 trail 0 Pass O.Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) PANAMA USD 4200 ASHE RD BAKERSFIELD CA 10/14/2011 10 :03 AM SUMP LEAK TEST REPORT 87VPR TEST STARTED 9:47 AM TEST STARTED 10/14/2011 BEGIN LEVEL 3.3234 IN END TIME 10:02 AM END DATE 10/14/2011 END LEVEL ?•. 3.3228 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 87STP TEST STARTED 9:47 AM TEST STARTED 10/14/2011 BEGIN LEVEL 2.2750 IN END TIME 10:02 AM END DATE 10/14/2011 END LEVEL 2.2774 IN LEAK THRESHOLD 0.002 IN TEST RESULT I%mll. DSLSTP TEST STARTED 9:47 AM TEST STARTED 10/14/2011 BEGIN LEVEL 3.8521 IN END TIME 10:02 AM END DATE 10/14/2011 END LEVEL 3.8535 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED PAN+MA U RD 4200 FIFID CA OAR''' 10:19 AN 10/ 1412x11 TEST REPORT VIA? gTUPR 18:03 AN T 4/20" TES T • a TARTER 13229 f,MTESZNEEN ND TiLPE1E Ve- DATE 101/ 013:4 2 1 901II1 N EVEL 0.002 NDL E5 a PA55ED 87STP 10:22 AM 1 6201h1 TEST STARTED TEST STARTED 10:22 AM 10/14/2011 BF_GIN LEVEL 2.2540 IN 10:37 AM _ END TIME END DATE 14/2011108NI2.2538 NENDLEVELLEAKTHRESHOLD0.0@,j ASSIN TEST RESULT DSLSTP TEST STARTED 10:22 AM 1 6201h1TESTSTARTED BEGIN LEVEL END TIME 10:37 AM 10/14/2011ENDDATE END 3.8562 IN 0.002 INTHRESHOLDPASSED TEST RESULT PANAMA USD 1 4200 ASHE RD BAKERSFIELD CA 10/14/2011 11:45 AM SUMP LEAK TEST REPORT DISP1 -2 TEST STARTED 11:30 AM TEST STARTED 110/14/2011 BEGIN LEVEL 2.1976 IN END TIME 11:45 AM END DATE 10/14/2011 END LEVEL 2.1971 IN LEAK THRESHOLD 10.002 IN TEST RESULT PASSED DISP3 -4 TEST STARTED TEST STARTED BEGIN LEVEL END TIME END DATE END LEVEL LEAK THRESHOI TEST RESULT 11:30 AM 10/14/2011 3.8557 IN 11:45 AM 10/14/2011 3.8563 IN D 0.002 IN PASSED PANAMA USD 4200 ASHE RD BAKERSFIELD CA 10/14/2011 12:02 PM SUMP LEAK TEST REPORT DISP1 -2 TEST STARTED 11:47 AM TEST STARTED 10/14/2011 BEGIN LEVEL 2.1972 IN END TIME 12 :02 PM END DATE 10/14/2011 END LEVEL 2.1974 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED DISP3 -4 TEST STARTED 11:47 AM TEST STARTED 10/14/2011 BEGIN LEVEL 3.8563 IN END TIME 12:02 PM END DATE 1011412011 END LEVEL 3.8564 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED SB989 TESTING FAILURE REPORT SITE NAME: PANAMA BUENA VISTA USD DATE: 10/14/11 THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: /Lo LABOR: 1-61"C PARTS INSTALLED: Al_*'L/ NAME: TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON - COMPLIANCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE.